Effects of Mother-Based Promotion of Exclusive Breastfeeding on Duration and Severity of Diarrhoea and Pneumonia: A Cluster Randomized Controlled Trial, Midlands Province, Zimbabwe, 2013

Abstract

Exclusive breastfeeding rates remain very low in most countries in sub Sahara Africa. We assessed the effects of a mother based intervention on duration of diarrhoea and pneumonia in communities that were trained and not trained in community infant and young child feeding (cIYCF) in the two districts in Midlands Province. Methods: We evaluated communities trained in cIYCF and or not trained and a mother based promotion of exclusive breastfeeding intervention (Newsletter) using a two-by-two factorial cluster randomized controlled trial. Consenting mother infant pairs identified within 72 hours of delivery were followed up at 14 and 20 weeks. Primary outcomes were duration of diarrhoea and pneumonia as well as severity of diarrhoea. Clusters were facility catchment areas assigned by an independent statistician using randomization generated by a computer in Stata 10. All admitting facilities and facilities at borders were excluded as buffer zones and eight clusters were analyzed: cIYCF- Newsletter (2 clusters, 90 mother infant pairs), cIYCF (88 mother infant pairs), Newsletter (92) and Control (87). Results: A total of 357 mother infant pairs (excluding twins) were available for analysis in all the clusters. The interaction between community infant and young child feeding training and the newsletter was statistically significant at 14 weeks (p = 0.022). The mean duration of diarrhoea was 2.9 days (SD = 0.9) among infants of mothers who resided in communities trained and received a newsletter compared to 5.2 days (SD = 1.1) in communities that received neither. The protective efficacy of the cIYCF plus newsletter was 76% during the first 20 weeks of life. In the two way ANOVA, the newsletter was more effective on duration of pneumonia (p = 0.010) at 14 weeks and remained significantly effective at 20 weeks (p <0.0001) while the preventive efficacy of the newsletter on pneumonia at 20 weeks was 74%. Conclusion: A combined community and mother-based promotion of exclusive breastfeeding reduces duration of diarrhoea at 14 weeks and at 20 weeks the newsletter worked better for both duration of diarrhoea and pneumonia compared to cIYCF training